American Journal of Transplantation

Cover image for Vol. 17 Issue 3

Edited By: Allan D. Kirk

Impact Factor: 5.669

ISI Journal Citation Reports © Ranking: 2015: 2/25 (Transplantation); 4/200 (Surgery)

Online ISSN: 1600-6143

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Volume 17, Issue 3 (March 2017)

Transplantation's considerable benefit is tempered by a continued requirement for nonspecific T cell–directed immunosuppression, and with it, impaired protective immunity, particularly against viral pathogens. This month we highlight articles covering the breadth of viral disease in transplantation, including well-known pathogens such as Epstein–Barr virus (Dharnidharka, AlDabbagh et al), cytomegalovirus (Zheng et al), and BK virus (Kuppachi et al), as well as less common pathogens such as West Nile virus (Wilson et al) and parainfluenza virus (Helanterä et al). We also feature a recent commentary on an emerging threat, Zika virus (Nogueira et al, and Blumberg and Fishman's editorial). These articles continue to underscore the immune consequences of organ transplantation, and impel continued work toward more precise immune management strategies. Cover design by Scott Behm and Deanna Hoskins, Duke University Department of Surgery.

2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2001


2017


17.3 cover

Volume 17, Issue 3 (March 2017)

Transplantation's considerable benefit is tempered by a continued requirement for nonspecific T cell–directed immunosuppression, and with it, impaired protective immunity, particularly against viral pathogens. This month we highlight articles covering the breadth of viral disease in transplantation, including well-known pathogens such as Epstein–Barr virus (Dharnidharka, AlDabbagh et al), cytomegalovirus (Zheng et al), and BK virus (Kuppachi et al), as well as less common pathogens such as West Nile virus (Wilson et al) and parainfluenza virus (Helanterä et al). We also feature a recent commentary on an emerging threat, Zika virus (Nogueira et al, and Blumberg and Fishman's editorial). These articles continue to underscore the immune consequences of organ transplantation, and impel continued work toward more precise immune management strategies. Cover design by Scott Behm and Deanna Hoskins, Duke University Department of Surgery.

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Volume 17, Issue 2 (February 2017)

Acquired immune responses are thought to be focused by specificity (e.g. foreign alloantigen), but are increasingly believed to be driven by broader signals indicating that a cell is in distress. This month, Matta et al provide a concise update on alarmins—small molecules released from distressed cells that provoke immune activation and amplification. We also provide a minireview by Scozzi et al that addresses neutrophils and their role in alloimmune response initiation, and an insightful paper by Lobb et al (also see the related editorial from Hauet and Thuillier) focusing on mitochondrial damage as a central source of innate signals of cellular injury. Together, these articles help shine light on the antigen independent mechanisms of alloimmunity. Cover design by Scott Behm, Duke University Department of Surgery.

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Volume 17, Issue 1 (January 2017)

On the cover this month: Tolerance, long viewed as a stable rejection-free condition, has more recently (and in keeping with Medawar's original definition) been recognized as a spectral state subject to “erosion” over time. This month, Young et al explore the influence of acute infections on established tolerance, pointing out that the immune plasticity required to ward off infectious threats also extends to the regulation involved in preventing allograft rejection. Also, we present the 2015 Banff Meeting Reports, highlighting the use of molecular diagnostics and new insights in cardiac antibody-mediated rejection. Cover design by Lauren Halligan, Duke University Department of Surgery.

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2016


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Volume 16, Issue 12 (December 2016)

On the cover: In the spirit of the holiday season, this month's AJT re-enforces our field's focus on the gift-giver at the core of all transplants, the organ donor. Eleven articles speak to our stewardship of this gift and our care for the donor, including two Viewpoints addressing the approach toward donor consenting processes (Allen and Reese) and our medical follow-up of donors (Kulkarni et al), an Original Article examining health insurance trends for living donors (Rodrigue and Fleishman), and four Brief Communications covering numerous donor-related issues. Cover image by Lauren Halligan, Duke University Department of Surgery.

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Volume 16, Issue 11(November 2016)

In 2011, belatacept was approved for use in kidney transplantation. Though its uptake by the transplant community has been gradual, owing at least in part to the many new mechanistic and logistical paradigms associated with its use, it is gaining a foothold in clinical practice. This month we feature several articles relevant to the growing use and acceptance of belatacept in clinical transplantation, including the final results of the pivotal BENEFIT-EXT study (Durrbach et al), a registry analysis of postapproval use of belatacept (Wen et al), and two articles describing expanded clinical use of belatacept. Ebcioglu et al describe belatacept use in an HIV-positive patient, and Krezdorn et al report on the use of belatacept in face transplantation. Also this month, we present the "What's Hot, What's New" summary of the 2016 American Transplant Congress (Levitsky and Gill), and an overview article from the ASTS Scientific Studies Committee (Fayek et al) with a useful summary of the SRTR data on liver transplantation. Cover image by Lauren Halligan, Duke University Department of Surgery.

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Volume 16, Issue 10 (October 2016)

Purinergic signaling pathways and their extracellular receptors specific for purines such as adenosine and ATP are evolutionarily ancient and widely distributed in human tissues. They have become increasingly well-recognized as critical in immune cell biology. As such, their manipulation is being scrutinized as a means of controlling alloimmune responses. This month, Zeiser et al provide a comprehensive review of this system and its potential in organ transplantation. Also, this issue highlights the 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology (Demetris et al), and specifically introduces criteria for diagnosing antibody-mediated liver rejection. Cover design by Lauren Halligan, Duke University Department of Surgery.


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Volume 16, Issue 9 (September 2016)

There is a longstanding recognition that liver disease precipitates kidney failure. However, as the breadth of comorbidities in patients deemed acceptable for liver transplantation has grown, numerous pathological processes have confounded the diagnosis and treatment of renal disease in patients awaiting and receiving liver transplantation. This month, the American Society of Transplantation's Liver and Intestine Community of Practice provide two minireviews, one focusing on management of pretransplant renal function (O’Leary et al) and the other directed toward posttransplant management (Levitsky et al). They both provide authoritative clinical insight. Also this month, “The AJT Report” examines the challenges presented by clinical research on deceased donors. Peter Abt and Sandy Feng discuss this topic in an editorial highlighting the need for, and difficulties of, clinical deceased donor research. Cover design by Ken North, North Design Group.

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Volume 16, Issue 8 (August 2016)

On the Cover: In June, the White House opened its doors to the organ transplant community, announcing a major effort to improve donor organ availability and reduce the wait time for people awaiting transplantation. This month, we focus on this important event with a special AJT Report, and an editorial from the leadership of the AST and ASTS. We also highlight a study from Axelrod et al showing the wide degree of variability in immunosuppressive drug choice following renal transplant. After 60 years of clinical transplantation, we still have no true standard of care. Cover design by Lauren Halligan, Department of Surgery, Duke University.

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Volume 16, Issue 7 (July 2016)

Transplantation chimerism refers to the coexistence of cells or tissues from two individuals within one recipient. All transplant patients are chimeras of sorts, with the allograft being of donor origin, but this degree of chimerism clearly does not lead to allograft tolerance. However, numerous studies have shown that augmenting the degree of chimerism (e.g. creating a state of mixed bone marrow chimerism) can lead to a state of tolerance, albeit with substantial risks related to donor bone marrow infusion. This month, we report two articles (Hu et al, page 2055, and Cameron et al, page 2066)showing that mobilization of recipient stem cells using a CXCR4 antagonist facilitates their engraftment within the donor organ, and in doing so creates a chimeric organ that can be maintained without immunosuppression. This novel take on the chimerism model of tolerance is intriguing for its simplicity and potential broad applicability, and is certainly worthy of attention. Cover design by Lauren Halligan, Duke University Department of Surgery.

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Volume 16, Issue 6 (June 2016)


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This month, AJT focuses on liver transplantation and its associated biology. Some highlights include a superb Comprehensive Review of the immune structural anatomy of the liver from Demetris et al, new advances in liver xenotransplantation from Navarro-Alvarez et al, and first-in-man experience using a novel ex vivo normothermic perfusion device from Ravikumar et al. These articles are accompanied by numerous other important contributions examining technical aspects of liver surgery and liver transplant outcomes, to bring the reader up to date with the many advances in contemporary liver transplantation. Cover design by Lauren Halligan, Duke University Department of Surgery.

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Volume 16, Issue 5 (May 2016)


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The shortage of kidneys continues to drive clinicians to expand the criteria for donor organ suitability, including the use of organs that are blood group ABO-incompatible (ABOi). This month, Axelrod et al provide an in-depth analysis of the cost and benefit of ABOi transplants in the United States, explicitly defining the incremental cost and decremental survival associated with this approach. Their thoughtful discussion, combined with an editorial by Held and McCormick, provides a broad perspective on this practice. Also, several articles appear analyzing the revised Banff 2013 criteria for antibody-mediated rejection (ABMR; see minireview by Haas and article by De Serres et al) and trials for the treatment of ABMR (see article by Viglietti et al and Montgomery's editorial). Cover design by Ken North, North Design Group

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Volume 16, Issue 4 (April 2016)


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Flow cytometry has become an exceptionally well-developed means of categorizing immune cells; what once was used to distinguish T cells from B cells now allows us to interrogate widely diverse characteristics of numerous cell lineages. In this month's AJT, two groups (Espinosa et al and Shabir et al) use multi-parameter flow cytometry to identify cells with evidence of prior antigen experience and loss of CD28, the targeted pathway of belatacept, to identify patients with a high risk of rejection, particularly following belatacept-based immunosuppression. As pointed out in an editorial by Murakami and Riella, these manuscripts provide insight into the mechanisms of rejection (and costimulation blockade resistant rejection, particularly) and potentially provide a means of prospectively identifying patients at risk for rejection. Cover design by Lauren Halligan, Duke University Department of Surgery

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Volume 16, Issue 3 (March 2016)
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Obesity is a known risk factor for numerous adverse outcomes in transplantation, including rejection and cardiovascular events. Increasingly, the inflammatory nature of adipose is being recognized, and these insights are nicely captured in a minireview from Wu et al. Also covered this month are novel basic observations related to rewarming and recovery of organs from donation after cardiac death donors, and numerous articles elucidating contemporary economic issues in living organ donation. Cover design by Ken North, North Design Group.

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Volume 16, Issue 2 (February 2016)


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Numerous strategies have emerged to provide beta cell replacement to patients with diabetes, including pancreas transplantation, islet cell transplantation, and most recently, the artificial pancreas. Each has advantages and disadvantages, but to date, none has distinguished itself as a satisfactory, scalable therapy. In this issue of AJT, we present numerous articles highlighting the current state of these three modalities. Brennan et al present 12-year follow-up on recipients of islet transplants using the Edmonton protocol, and Moassesfar et al present a study comparing pancreas to islet transplantation. Both are commented upon in an editorial by Markmann. Forlenza et al present their promising results of a closed-loop artificial pancreas trial. Singh et al and King et al provide important analyses of complications related to pancreas transplantation, while Gruessner and Gruessner provide data from the International Pancreas Transplant Registry on pancreas after islet transplant results. Cover design by Lauren Halligan, Duke University Department of Surgery.

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Volume 16, Issue 1(January 2016)


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On the cover: Cardiac transplantation has become an exceptionally successful treatment for end-stage heart failure, but it remains plagued by the development of cardiac allograft vasculopathy (CAV), a progressive fibrosing lesion of the coronary arteries that eventually results in ischemic failure of the transplanted heart. In this issue of AJT, Loupy et al provide strong evidence that alloantibody formation is a prominent culprit in this disease. The finding, combined with the association between CAV and recipient alloantibodies reported by Starling et al, underscore the need for controlling humoral immune responses in recipients and screening for alloantibody formation posttransplantation. See also the thoughtful editorial by Margaret Burke. Cover art by Lauren Halligan, Duke University Department of Surgery.

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Volume 15, Issue 12 (December 2015)


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On the cover this month: One of the earliest histocompatibility tenets for organ transplantation was that of ABO blood group compatibility, which largely followed the same rules as blood transfusion. However, strict adherence to these rules has led to disadvantages in organ allocation that segregate not only by blood group, but also by associated ethnic group. The result has disadvantaged some minority recipient groups. In this issue of AJT, Williams et al (page 3134) present landmark analysis of a formal initiative allowing kidneys expressing low levels of the A blood group (so-called blood group A2) to be transplanted to blood group B individuals with low titer of anti-A antibody. The results show this to be a safe practice and mitigate some of the disparity associated with the older matching paradigm. This is a wonderful example of mechanistic understanding being leveraged to provide clinical impact. Cover design by Ken North.

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Volume 15 Issue 11 (November 2015)


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On the cover this month:Although much attention is appropriately focused on the immunobiology of allotransplantation and its relationship to the immune management of transplant recipients, it is important to reflect on the critical importance of superb surgical technique in determining transplant outcomes. In this issue, Heylen et al (page 2900) look at the relationship between anastomosis time and subsequent development of allograft fibrosis, pointing out that the surgical procedure should itself be considered an immunological variable. Knechtle and Sudan (page 2791) provide editorial comment on the continued importance of technical mastery, and in a related article, Ausania et al (page 2955) remind us of the consequences of poor technique in pancreas allograft recovery. Also in this issue, we provide the basic (page 2802) and clinical (page 2808) “What's Hot, What's New” overviews of the 2015 American Transplant Congress.

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Volume 15 Issue 10 (October 2015)

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Paired exchange has emerged as an increasingly accepted means of fostering live donor kidney transplantation. As programs have expanded, practitioners are now moving beyond simple proof-of-concept implementation, and on to process optimization. This month's AJT features three articles (Bray et al, page 2636; Fumo et al, page 2646; and Flechner et al, page 2712) germane to the incremental improvement of paired exchange processes, particularly those dealing with imperfections and progression failure inherent in processes dependent on complex human interactions. Gentry and Segev provide commentary on page 2539. Cover image by Ken North, North Design Group.

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Volume 15 Issue 9 (September 2015)


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Hyperlipidemia is a common comorbid condition in transplant patients, one that is exacerbated by the immunosuppressive drugs used to prevent rejection. Long known to worsen cardiovascular disease, two articles from the Iacomini lab (Bagley et al and Yuan et al ) now demonstrate a direct impact on allospecific lymphocyte function, implicating this condition in the rejection process directly. These studies have clear clinical implications, and pull together two apparently distinct disease processes into a common disease paradigm. Cover design by Ken North, North Design Group.

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Volume 15 Issue 8 (August 2015)


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HIV and organ transplantation each emerged as signifi cant disruptive forces in healthcare in the 1980s. Our rudimentary understanding of both led us to draw boundaries around their management that have, with time, been erased, as their perceived mutual exclusivity has given way to an appreciation that transplantation can be an important therapeutic modality in many HIV-related comorbidities. This month, we highlight articles relevant to the HIV Organ Policy Equity (HOPE) Act, new legislation permitting HIV+ donors to donate organs to HIV+ recipients. “The AJT Report” covers practitioner perspectives of this new law (page 2015), and Boyarsky et al (page 2023) review clinical decision issues relevant to HIV+ to HIV+ transplantation. Articles by Locke et al (page 2096) and Richterman et al (page 2105) report new data on the management of HIV+ recipients and the prevalence of HIV+ donors, respectively. Also, be sure to check out the new AST/AJT online journal club taking place Monday, August 31, at 4:00 pm ET. Participation is free to all; register at myAST.org/journalclub. Cover design by Ken North, North Design Group.

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Volume 15 Issue 7 (July 2015)


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The first interaction between a donor and recipient occurs at the vascular endothelium. Indeed, the field of vascular biology has become increasingly defined as a bi-directional interface involving both afferent and efferent signals that markedly influence a transplanted organ’s integrity from the minute of implantation through decades of subsequent function. This month, Abrahimi et al present a masterful review of this important topic that shines light on the multiple pathways and responses driving organ health and disease. Cover design by Ken North, North Design Group.

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Volume 15 Issue 6 (June 2015)


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Science tends to organize itself into systems with common anatomical characteristics: the cardiovascular system, the neurological system, etc. However, all of these taxonomies discount the fundamental goal of maintenance of general homeostasis, in that all things must have points of interaction. In this issue of AJT, Paunicka et al highlight the relationships between the neurological system and the immune system, demonstrating that neural input influences subsequent immune responses in the eye and can in fact alter corneal allograft rejection. This article is complemented by a thoughtful editorial by Blanco and Saban, and a review of the mechanistic means by which these relationships can occur, authored by Larregina et al. These interconnections are fascinating in their own right, but open up numerous new therapeutic possibilities. Cover design by Ken North, North Design Group.

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Volume 15 Issue 5 (May 2015)


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Few would argue that the most sacred tenet of organ transplantation is the respect of living donors. However, the subject of donor incentives has become a substantial “elephant in the room” as considerations of donor safety, transplant finances, and organ shortages have intersected. This month we examine several viewpoints on this issue, including a consensus opinion from the AST and ASTS (Salomon et al), an ethical discussion from Fisher et al, and a scholarly opinion piece from Delmonico et al. Cover design by Ken North, North Design Group.

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Volume 15 Issue 4 (April 2015)


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Despite exceptional advances in immune management, most transplanted organs succumb over time to some form of progressive fibrosis. This month, Peter Boor and Jürgen Floege provide a comprehensive review of renal allograft fibrosis, highlighting key mechanisms of disease, therapeutic targets, and clinical issues emerging in this unsolved problem. Also see the meeting report on best practices in live kidney donation. Cover design by Ken North, North Design Group.

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Volume 15 Issue 3 (March 2015)


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Transplantation has always been viewed as a multispecialty discipline, dependent on the aggregate actions of many diverse professionals. As healthcare reform moves us to more explicitly value the actions involved in care delivery, transplant clinicians will need to determine how best to establish compensation methods that recognize the complexity of the profession. This month, Abouljoud et al present a novel model for establishing value for the purpose of setting compensation. Also see the editorial comment by Abecassis and Pearson and a related brief communication on transplant surgeon burnout by Jesse et al. Cover design by Ken North, North Design Group.

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Volume 15 Issue 2 (February 2015)


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Survival after liver transplantation is dependent on immediate graft function, which in turn is heavily impacted by organ preservation during cold storage. This month, AJT features a report from the European Liver Transplant Registry that shows significant differences in patient survival based on preservation solution use, with marked differential survival in settings that involve prolonged cold ischemic times or split liver grafts. See the article by Adam et al and an accompanying editorial by Zoe Stewart. Also see the What's Hot, What's New Basic Science and Clinical Science reports from the World Transplant Congress. Cover design by Ken North, North Design Group.

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Volume 15 Issue 1 (January 2015)


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With donor organs in perpetual short supply, liver transplant surgeons have endeavored to create techniques to allow for safe, live donor partial hepatectomy to facilitate live donor liver transplantation (LDLT). This is arguably the most technically demanding transplant procedure, and one that has little room for error on the donor or recipient side. In this issue, we present a comprehensive review from S.-G. Lee, detailing his extensive and highly successful experience with this procedure. The article and its accompanying videos will be of great use to those engaged in liver transplantation, not only highlighting the anatomical nuances of the procedure, but also presenting important insights into the unique physiology of the partial liver graft. Cover design by Ken North, North Design Group.

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Volume 14 Issue 12 (December 2014)


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Regulatory T cells (Tregs), specifically CD4+ T cells that express FoxP3 and the high-affinity IL2 receptor CD25, have been increasingly recognized as providing critical balance to protective and alloreactive cytotoxic T cell responses. This has, in turn, spawned growing interest in harnessing Tregs as potential tools for the control of T cell–mediated allograft rejection, with many proposing that ex vivo expanded Tregs could be used therapeutically to induce tolerance. This month, Singh et al show, in a rigorous preclinical primate model, that sirolimus helps foster Treg persistence and function after ex vivo expansion and adoptive transfer. The work is an important step in designing a Treg-based clinical trial and a nice demonstration of cellular transfer techniques in primates. Cover design by Ken North, North Design Group.

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Volume 14 Issue 11 (November 2014)


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Substantial progress has been made in the last 5 years in bioengineering and regenerative medicine. This month, Taylor et al provide an update on the remarkable advances in cardiac construction, and the role this emerging option may play in the future of multimodal therapy for patients with heart failure. Also see our Images in Transplantation section for the opportunity to earn CME credit. Cover design by Ken North, North Design Group.

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Volume 14 Issue 10 (October 2014)


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Hypothermia has been a central component of preservation strategies since the beginning of organ transplantation, but while this has been necessary with existing preservation solutions, it is increasingly recognized that deep hypothermia has adverse consequences that likely impair organ reanimation. This month, Lowalekar et al show compelling large animal data suggesting that a new preservation approach facilitates ambient temperature storage of donor hearts with superior function relative to hypothermic storage. Also visit the AJT Video Library for additional content from this article. Cover design by Ken North, North Design Group.

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Volume 14 Issue 9 (September 2014)


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Intestinal transplantation remains a challenging procedure, both technically and immunologically. Over the past decade and in contrast to most organs, the number of intestinal transplants performed has steadily declined, reflecting the significance of these challenges and improvements in alternative therapies. Debra Sudan reviews the current, dynamic state of intestinal transplantation on page 1976. Also see the meeting report on page 1992 for recommendations on posttransplant diabetes mellitus. Cover design by Ken North, North Design Group.

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Volume 14 Issue 8 (August 2014)


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Donor safety is arguably the most critical consideration in organ transplantation. While live donor kidney transplantation has advanced based on the premise that healthy donors are not disadvantaged with regard to long-term mortality, this assumption has not been specifically examined as it relates to older donors, and this is increasingly relevant as the population in general ages. This month, Reese et al (page 1853) examine the long-term survival of donors over the age of 55 and show that long-term mortality is not adversely affected. This provides direct evidence as to the relative safety of kidney donation for healthy older patients and validates current restrictive practices limiting donation to patients without significant comorbidities. Also, see the online version of the Iyer et al article (page 1744) on DCD heart protection for two accompanying videos. Cover design by Michael Konomos.

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Volume 14 Issue 7 (July 2014)


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Referral for kidney transplantation is the initial step putting patients with renal failure on the path to dialysis independence. However, Patzer et al (page 1562) show that patient referral rates vary widely across the United States, with many dialysis centers referring nobody for transplantation and centers in the Southeast (Network 6) doing particularly poorly. Patzer and Pastan (page 1499) and Srinivas (page 1506) offer competing but compatible solutions in a point/counterpoint commentary. Also, in the Basic Science section, we highlight three novel strategies to improve islet engraftment. See articles by Hlavaty et al (page 1523), Luan and Iwata (page 1533), and Koulmanda et al (page 1543). Cover design by Ken North, North Design Group.

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Volume 14 Issue 6 (June 2014)


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Immunity has generally been understood as being at odds with the myriad microbes that thrive on and in us, but increasingly there is recognition that human immunity coexists and productively interacts with our microbiota. This intersection and its implications for transplant immune management are comprehensively reviewed by Alegre et al (page 1236). This month’s issue also takes a deep dive into the complexities of program outcomes monitoring, specifically examining the Bayesian methodology being adopted by the Scientific Registry of Transplant Recipients. See the editorial by Schold and Axelrod (page 1231), and viewpoint (page 1271) and article (page 1310) by Salkowski et al. Cover design by Ken North, North Design Group.

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Volume 14 Issue 5 (May 2014)


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Hepatitis C virus (HCV) remains one of the most common indications for liver transplantation and a significant problem for much of the chronic dialysis population. Importantly, although liver transplantation is an effective remedy for HCV-related liver failure, posttransplant HCV recurrence remains a near certainty. However, many new antiviral agents are emerging with legitimate promise to not only control HCV, but eliminate it. Gane and Agarwal (page 994) provide an update on the drugs that may potentially dethrone HCV as a top indication for transplantation. Also in this issue, Stock et al (page 1136) make novel observations regarding an association between sirolimus exposure and a lower frequency of CD4 lymphocytes containing HIV DNA, suggesting that immunosuppression required for kidney transplantation in the HIVinfected recipient may impact the level of HIV persistence. Cover design by Ken North, North Design Group.

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Volume 14 Issue 4 (April 2014)


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Allograft biopsies have served as the standard for diagnosis in organ transplantation, but their utility has been limited by sampling error. Increasingly, practitioners have looked toward sampling techniques that are less invasive than tissue biopsy and at the same time reflect the entire organ’s condition. In this issue we highlight two articles (pages 831 and 841) examining the utility of bronchoalveolar lavage in assessing lung transplant rejection. Both of these studies find that there is substantial untapped information to be gleaned from this secretory product—information that has both diagnostic and mechanistic value. We also present a case report (page 960) of a rare metabolic disorder, lathosterolosis, that was successfully treated by liver transplantation, and surprisingly mollified an autism phenotype associated with this disease. Cover design by Ken North, North Design Group.

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Volume 14 Issue 3 (March 2014)


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Allotransplantation in all its forms begins with organ donors. This month’s cover features a unique approach to organ procurement that utilizes a centralized organ donor facility rather than having organs procured at the donor hospital. Doyle et al (page 615) review a decade of liver donation performed in this facility. We also have articles on live donor risks and benefits, and novel approaches to deceased donor trial conduct. Cover design by Ken North, North Design Group.

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Volume 14 Issue 2 (February 2014)


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Antibody-mediated rejection (ABMR) is a significant issue in kidney transplantation that presents in highly variable ways. Its variability has confounded both its diagnosis and mechanistic definition. In this issue of AJT, we highlight current concepts surrounding ABMR with several relevant laboratory science papers, a comprehensive review, and the meeting report from the most recent Banff meeting. Cover design by Ken North, North Design Group.

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Volume 14 Issue 1 (January 2014)


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Islet transplantation is performed by injecting islets into the recipient portal vein. This month, Esposito et al (page 202) use sophisticated magnetic resonance imaging (MRI) techniques to evaluate the impact of islet embolization into the portal system on hepatic blood flow, showing that flow is dynamic after transplantation, and suggesting that a reduction in flow associates with early islet graft loss. Liver AUC60 (top panels) and Ktrans (bottom panels) maps derived from dynamic-contrast enhancement MRI studies before (left) and after (right) islet transplantation in a patient with early graft failure show a strong reduction in liver perfusion 7 days after transplantation.
Cover design by Ken North, North Design Group.

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Volume 13 Issue 12 (December 2013)


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The use of rabbit antithymocyte globulin (RATG) has gained increasing popularity in North America as an induction immunosuppression strategy, particularly in kidney transplantation, with over 50% of centers using this preparation on a routine basis. However, despite its heavy usage and longstanding presence in the transplant armamentarium, its derivation from immunized rabbits and polyclonal makeup make its true content and mechanism of action somewhat of a black box. This month, Popow et al (page 3103) lift the lid to this box a bit, providing the most up-todate analysis of RATG’s content and providing additional insight into its therapeutic mechanism.
Cover design by Ken North, North Design Group.

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Volume 13 Issue 11 (November 2013)


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Immunobiology is a study of homeostatic mechanisms fostering survival. However, it is increasingly evident that regulated cell death is an important component of survival. Numerous mechanisms of cell death have been characterized, and this month, AJT highlights the mechanisms and infl uence of necroptosis. Lau et al provide insights into the role of necroptosis in ischemia-reperfusion injury (page 2805) and Linkermann et al provide a useful overview of necroptosis in general (page 2797), highlighting its potential role in allograft survival. Also see a thoughtful editorial by Mannon providing additional perspective on this dynamic topic (page 2785).
Cover design by Ken North, North Design Group.

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Volume 13 Issue 10 (October 2013)


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Antibodies specific for HLA molecules have long been known to negatively influence allograft function and survival. This month, three manuscripts report on antibodies with atypical specificities, including two focusing on angiotensin II type 1 receptor-specific antibodies (see articles by Giral et al and Taniguchi et al on pages 2567–2589) and one addressing polyreactive antibodies (see article by Porcheray et al on pages 2590–2600), indicating that the breadth of an antibody response towards a transplanted graft may significantly influence the organ’s ultimate fate.

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Volume 13 Issue 9 (September 2013)


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In the continued quest for refined methods of live donor liver donation and optimized means of minimizing donor morbidity, three groups present case reports on their techniques for laparoscopic live donor liver donation. See articles by Samstein et al (page 2462), Soubrane et al (page 2467) and Troisi et al (page 2472). As this technically challenging procedure performed on healthy donors is not without substantial risks and ethical concerns, Mohamed Akoad and Elizabeth Pomfret provide editorial perspective on page 2243.

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Volume 13 Issue 8 (August 2013)


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Gentry et al (page 2052) present a provocative analysis of means to eliminate regional disparities in liver allocation in which they show that regional sharing of donor organs best addresses the issue of disparity when combined with an aligned reorganization of the existing regions. A thoughtful commentary on this work by Yeh and Hunsicker is found on page 1949. Also, this month’s issue contains a Special Article on the new Public Health Service Guideline for Reducing HIV, HBV and HCV Transmission Through Organ Transplantation (page 1953).

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Volume 13 Issue 7 (July 2013)


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Transplantation has been closely linked to basic science from its beginnings. However, as the questions being asked in modern clinical trials become increasingly nuanced and dependent on multicenter clinical trials, the ability to derive mechanistic information from patients at multiple sites has been difficult to orchestrate. This month, AJT features five Brief Communications from collaborative research groups in North America and Europe demonstrating that advanced mechanistic study can be coordinated in support of multicenter clinical trials. See reports in the Clinical Trials in Organ Transplantation series, beginning on page 1859.

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Volume 13 Issue 6 (June 2013)


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“Keeping an eye” on the mechanisms of allograft rejection, Tan et al (page 1461) present an elegant model for studying chemokines produced locally within corneal allografts and use it to demonstrate the dynamic behavior of infiltrating effector T cells. In addition to the static images in the print version, be sure to view the in vivo movies at http://goo.gl/cAEhl

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Volume 13 Issue 5 (May 2013)


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This month, Salehi et al (page 1282) take advantage of a unique clinical opportunity, auxiliary liver transplantation, to study the basic biology of liver regeneration. The study not only provides new information on the molecular processes associated with hepatic regeneration, but also highlights the creative use of a clinical transplant scenario to directly investigate human biology in vivo. Opportunities like this are often part of transplantation and will increasingly need to be exploited to provide the most relevant scientific information in an increasingly competitive research funding environment.

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Volume 13 Supplement 5 (April 2013)


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Special Issue: 2013 American Transplant Congress Abstracts

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Volume 13 Issue 4 (April 2013)


Vol 13 Iss 4

Garonzik-Wang et al (page 936) present the results of a national study examining center-level utilization of various categories of livers that suggests that high waitlist disease severity, organ availability, and transplant volume are the main drivers of aggressive utilization of higher-risk livers. The study leads to questions as to what defines appropriately aggressive organ utilization, and how centers should respond to metrics quantifying aggressive use of marginal livers, or any other ruler of aggressiveness, to examine and alter their liver acceptance practice. Also see related editorial by Lai and Feng on page 837.

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Volume 13 Supplement 4 (March 2013)


Vol 13 S4


Special Issue: The American Society of Transplantation Infectious Disease Guidelines 3rd Edition
Upper left: GMS stain of a lung biopsy in a liver transplant patient with disseminated coccidioidomycosis. Provided by Dr. Rachel Miller, University of Iowa.
Upper right: Dermatomal grouped vesicles consistent with herpes zoster virus reactivation in a transplant recipient. Provided by Dr. Misha Rosenbach, Perelman School of Medicine of the University of Pennsylvania.
Lower left: Skin biopsy of a pancreas transplant recipient with cutaneous strongyloidiasis. Provided by Drs. Steven D. Mawhorter and Melissa Piliang, Cleveland Clinic, and Dr. Wendy Armstrong, Emory University School of Medicine.
Lower right: Pneumocystis and nocardial pneumonia with pneumothorax in a liver transplant recipient. Provided by Dr. Sang-Oh Lee, University of Ulsan College of Medicine.

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Volume 13 Issue 3 (March 2013)


Vol 13 Iss 3

A provocative article from Fadi Lakkis’s lab in this month’s issue (page 580) demonstrates a broad spectrum of rejection seen when outbred, wild-type mice are used rather than the standard laboratory inbred strains. The article helps refine the tools used for mechanistic study, and will improve the field’s ability to study the complexities of outbred (e.g. human) allograft rejection in a tractable mouse model system.

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Volume 13 Supplement 3 (February 2013)


Vol 13 S3

Special Issue: Cytomegalovirus and Human Herpesvirus Infections in Solid Organ Transplantation
Immune control of herpesvirus infection. Primary infection with members of the herpesvirus family typically occurs via the mucosal epithelium.

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Volume 13 Issue 2 (February 2013)


Vol 13 Iss 2

One of the most critical factors dictating the success of free tissue transplantation is the development of sufficient vascular supply through posttransplant angiogenesis. This month, Kuehl et al (page 286) demonstrate that neonatal liver stimulates much more robust angiogenesis, seen as a blush of vascularity in their novel model of in vivo hepatic free tissue transfer, and use this model to describe some of the features potentially contributing to this phenomenon.

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Volume 13 Supplement 2 (January 2013)


Vol 13 S2

Special Issue: ASTS 13th Annual State of the Art Winter Symposium, January 2013

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Volume 13 Supplement 1 (January 2013)


Vol 13 S1

Special Issue: Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients 2011 Data Report

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Volume 13 Issue 1 (January 2013)


Vol 13 Iss 1

This month's AJT pays tribute to Joseph E. Murray, the father of clinical organ transplantation, who passed away in November 2012. Dr. Murray revolutionized transplantation, medicine in general and indeed the way the public perceived the promise of modern medicine. A memorial tribute is provided by Stefan Tullius, Chief of Transplant Surgery at Brigham and Women's Hospital, where Dr. Murray performed the first successful kidney transplant in 1954 (see article on page 5).

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Volume 12 Supplement 4 (December 2012)


Vol 12 S4

Special Issue: Focus on Small Bowel Transplantation: Selected Works from the XII International Small Bowel Transplant Symposium
Small intestinal grafts after procurement (top row) and following reperfusion (bottom row) from various sized donors (left to right, pediatric to adult) used to quantify the length of the small bowel, an important factor in determining bowel sufficiency. See article by Gondolesi et al on page S49. This is one study highlighted in this supplement presenting outstanding articles from the XII International Small Bowel Transplant Symposium of the Intestinal Transplant Association.

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Volume 12 Issue 12 (December 2012)


Vol 12 Iss 12

Hospital readmission rates are likely to become increasingly cited as a key metric in healthcare reform, particularly under pay-for-performance funding formats. This month, McAdams-DeMarco et al (page 3283) provide an interesting look at hospital readmission rates post–kidney transplantation, showing that nearly a third of transplanted patients are readmitted in the first 30 days posttransplant. A thoughtful editorial by Kaplan and Sweeney (page 3171) points out the importance of understanding this metric as it clearly relates to the quality of patient care and may well be used to influence reimbursement in the future.
Cover design by Ken North, North Design Group.

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Volume 12 Issue 11 (November 2012)


Vol 12 Iss 11

This issue highlights the current state of Simultaneous Liver–Kidney Transplantation (SLKT). Shown are data from a recent SLKT summit report by Nadim et al (see page 2901) indicating the increased use of this combined transplant strategy, in tandem with its wide regional variation and poorly defined reported indication. See numerous additional articles on this topic including an editorial by Feng and Trotter (page 2869); articles by Levitsky et al (page 2949), Ruebner et al (page 2958) and Hibi et al (page 2966); and a brief communication by Nadim et al (page 3119).

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Volume 12 Issue 10 (October 2012)


Vol 12 Iss 10

Transplantation has typically been organized around organ preservation, slowing the demise of a procured organ until it can be transplanted, ideally as soon as possible. This month highlights the application of organ repair, improving the graft ex vivo to facilitate the use of an otherwise suboptimal organ, at a remote location. This is the first report of such a repair process occurring using an organ shipped to a collaborative site for resuscitation and returned for transplantation; this raises the potential for organ repair centers to aid in the optimal use of the available organs. See case report by Wigfield et al on page 2838.

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Volume 12 Issue 9 (September 2012)


Vol 12 Iss 9

Diagrammatic representation of a national paired kidney donor exchange program that facilitated the transplantation of over 270 patients with excellent clinical outcomes. The study highlights the growing use of paired exchange to facilitate the transplantation of highly sensitized individuals and individuals with incompatible donors, and represents a watershed experience in the national acceptance of this approach. See article by Melcher et al on page 2429.

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Volume 12 Issue 8 (August 2012)


Vol 12 Iss 8

An educated chef can find many good uses for the typically eschewed overripe banana; so too can the prepared transplanter find uses for organs that are past their prime. See related editorials (Tedesco on page 1969, Friedewald on page 1971, and Gill on page 1973) and articles (Mohan et al on page 2098 and Woodside et al on page 2106) as well as other donor-relevant articles by Ross et al (on page 2115), Bingaman et al (on page 2125) and Venkataramani et al (on page 2133).
Cover design by Ken North, North Design Group.

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Volume 12 Issue 7 (July 2012)


Vol 12 Iss 7

A schematic depicting the potential actions of CD28-specific biologic agents. See minireview by Poirier et al (page 1682) for an overview of the opportunities and challenges associated with selective costimulation blockade.

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Volume 12 Issue 6 (June 2012)


Vol 12 Iss 6

There is marked variation in the stroke- and trauma-related death rate across the United States, and this relates to the number of deaths eligible for donation. See brief communication by Sheehy et al on page 1598.

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Volume 12 Supplement 3 (May 2012)


Vol 12 S3

Special Issue: 2012 American Transplant Congress

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Volume 12 Issue 5 (May 2012)


Vol 12 Iss 5

The striking impact of de novo donor-specific antibody (but not non-donor-specific alloantibody) on graft survival is made apparent by an article by Wiebe et al (see page 1157). Through the use of protocol biopsies, they show that histological evidence of graft injury is evident well prior to clinically apparent graft dysfunction.

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Volume 12 Issue 4 (April 2012)


Vol 12 Iss 4

An intestinal allograft biopsy from a NOD2 wild-type recipient showing normal architecture with respect to cellular organization and the presence of lamina propria myeloid cells expressing CX3CR1 (green) with well-developed transepithelial dendrites (F-actin, red). These properties are proposed as critical for an intestinal allograft to resist microbe-induced inflammation that can be mistaken for alloantigen-directed rejection. See article by Lough et al on page 992.

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Volume 12 Issue 3 (March 2012)


Vol 12 Iss 3

The relative influence of risk factors for fracture after kidney transplantation. See article by Nikkel et al on page 649. Image courtesy of the Department of Radiology and Imaging Sciences, Emory Healthcare.

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Volume 12 Issue 2 (February 2012)


Vol 12 Iss 2

Despite exceptional improvement in essentially all aspects of its biology, organ transplantation remains challenged by social barriers to its equitable delivery. See "AJT Report" (page 269), editorial by Abbott and Gaston (page 273), and articles by Kucirka et al (page 351) and Patzer et al (pages 358 and 369) for related content.

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Volume 12 Supplement 2 (January 2012)


Vol 12 S2

Special Issue: ASTS 12th Annual State of the Art Winter Symposium

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Volume 12 Supplement 1 (January 2012)


Vol 12 S1

Special Issue: Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients 2010 Data Report

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Volume 12 Issue 1 (January 2012)


Vol 12 Iss 1

Preservation of renal tubular cilia in a transplanted kidney is demonstrated by immunofluorescence and immunohistochemical staining (inset) following retinoic acid therapy. This therapy, designed to target the Wnt and Hedgehog pathways, provides proof-of-concept that changes resulting from chronic allograft injury can be mollified pharmacologically. See article by von Toerne et al on page 55 and associated editorial by Fabian and Humphreys on page 5.

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Volume 11 Issue 12 (December 2011)


Vol 11 Iss 12

Arteriolar hyalinization is frequently cited as evidence of calcineurin inhibitor (CNI) toxicity. In this issue, Snanoudj and colleagues provide clear evidence that although these changes are more frequent in patients on CNIs, they are not specific to CNI-associated injury. See article on page 2635 and accompanying editorial by Mengel et al on page 2549.

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Volume 11 Issue 11 (November 2011)


Vol 11 Iss 11

A pediatric patient with acute hepatic failure provides the diagnostic dilemma for the first installment of “Images in Transplantation.” This new feature provides an opportunity for readers to test and add to their knowledge, and receive Continuing Medical Education credit. See page 2533 for details.

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Volume 11 Issue 10 (October 2011)


Vol 11 Iss 10

The influenza virus. This month, AJT presents several articles detailing the recommended influenza vaccine strategies for transplant patients and the population at large, and unique aspects of influenza vaccine performance in transplant recipients. See special article by Kumar et al on page 2020, a brief communication by Cordero et al on page 2205 and Reports from the CDC: MMWR on page 2250.
Cover figure by Russell Kightley Media.

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Volume 11 Issue 9 (September 2011)


Vol 11 Iss 9

Practice and Outcomes Variation: Which Surgeon Are You? Estimated cumulative proportion of patients with surgical site infection (SSI) after liver transplantation by surgeon. See Hellinger et al, pages 1877–1884.

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Volume 11 Issue 8 (August 2011)


Vol 11 Iss 8

Number of deceased donor kidney transplants by race before and after the elimination of allocation points for HLA-B matches. See article by Ashby et al on page 1712.

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Volume 11 Issue 7 (July 2011)


Vol 11 Iss 7

B cells, plasma cells and the effects of allospecific antibodies and complement continue to present barriers to long-term allograft survival. See minireview by Clatworthy (page 1359) and related articles by Raedler et al (page 1397) and Loupy et al (page 1478).

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Volume 11 Issue 6 (June 2011)


Vol 11 Iss 6

Donor-derived malignancy and other donor-derived risks are featured in this issue of AJT. Shown on the cover is fluorescence in situ hybridization of the Y chromosome illuminating male tumor cells (yellow spots in red cells) in the renal allograft of a female recipient. See the article by Olagne et al on page 1260 and other articles addressing risks of donor-transmitted diseases.

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Volume 11 Issue 5 (May 2011)


Vol 11 Iss 5

A graphic depiction of the variation in liver Donor Risk Index by organ procurement region in the United States suggests that the quality of the deceased donor livers that patients receive is variable and dependent in part on a center effect. See article by Volk et al on page 958.

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Volume 11 Supplement 2 (April 2011)


Vol 11 S2

Special Issue: 2011 American Transplant Congress

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Volume 11 Issue 4 (April 2011)


Vol 11 Iss 4

A word cloud created from the titles of the top 100 most cited articles from the ten surgical journals with the highest impact factors over the last decade. See McGee and McGee's Letter to the Editor, pages 871–872.

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Volume 11 Issue 3 (March 2011)


Vol 11 Iss 3

The entire transplant community pauses to remember the historic and selfless contributions of Ronald Herrick, the first kidney donor. See “The AJT Report” on page 415 and the special feature on page 419.

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Volume 11 Issue 2 (February 2011)


Vol 11 Iss 2

A facial CT scan image demonstrating the bony integration of one of many face allografts reported in this edition of the American Journal of Transplantation. See case reports by Lantieri et al (page 367), Siemionow et al (page 379) and Pomahac et al (page 386).

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Volume 11 Supplement 1 (January 2011)


Vol 11 S1

Special Issue: ASTS 11th Annual State of the Art Winter Symposium

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Volume 11 Issue 1 (January 2011)


Vol 11 Iss 1

A conceptual triangulation of the fundamental diagnostic components of Antibody Mediated Rejection. See article by Loupy et al on page 56.

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Volume 10 Issue 12 (December 2010)


Vol 10 Iss 12

The blood supply to the human biliary system (A) in health, and (B) following a donation after cardiac death (DCD) liver transplant with micro-thombosis. Hashimoto et al propose this as a predominant mechanism of ischemic-type biliary strictures. See article on page 2665.

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Volume 10 Issue 11 (November 2010)


Vol 10 Iss 11

The Atlanta skyline. With this issue the Editorial Office moves to Emory University in Atlanta, Georgia. See editorial by Kirk on page 2385.
Photo Credit: Eric Kirk Photography

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Volume 10 Issue 10 (October 2010)


Vol 10 Iss 10

Loss of nephrin expression in glomeruli of kidney-transplanted patients under m-TOR inhibitor therapy. Shown is the immunofluorescence staining for nephrin in glomeruli of a pretransplant donor kidney biopsy (left figure) and of a posttransplant kidney biopsy before (center figure) and after introduction of m-TOR inhibitor therapy (right figure) in a representative patient. See article by Biancone et al on page 2270.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 9 (September 2010)


Vol 10 Iss 9

Schematic illustration of domino paired donation chain. See article by Lonze et al on page 2154.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 8 (August 2010)


Vol 10 Iss 8

Posttransplant lymphoproliferative disorder in a liver transplant patient. See article by Collett et al on page 1889.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 7 (July 2010)


Vol 10 Iss 7

Thrombotic microangiopathy after kidney transplantation. See minireview by Noris and Remuzzi on page 1517.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 6 (June 2010)


Vol 10 Iss 6

Improvement 12 months after switching to sirolimus in a 67-year-old male having been on immunosuppression for 278 months at baseline. See article by Salgo et al on page 1385–1393.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 5 (May 2010)


Vol 10 Iss 5

May 2010 marks the 10th year of publication of AJT and represents an occasion to think about the project and its future directions.
Cover design by Ken North of North Design Group.

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Volume 10 Supplement 4 (April 2010)


Vol 10 S4

Special Issue: 2010 American Transplant Congress

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Volume 10 Supplement 3 (April 2010)


Vol 10 S3


Special Issue: The 2009 SRTR Report on the State of Transplantation

Encouraging trends in intestine transplantation: Intestine transplantation results have improved dramatically over the past decade. Waiting list mortality has significantly decreased, and one year patient and graft survival approach 80%. Increased numbers of waiting list registrations and transplants have also been noted, but significant clinical challenges remain. See the article by Mazariegos et al on page 1020–1034.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 4 (April 2010)


Vol 10 Iss 4

MicroRNAs are transcribed and processed within the cell and constitute an important mechanism of posttranscriptional regulation of gene expression. See article by Martinez et al on page 713–719.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 3 (March 2010)


Vol 10 Iss 3

Molecular model of belatacept consisting of two CTLA-4 domains (represented in two separate colors, cyan and blue) containing active site mutations (rendered in green) and the IgG1 Fc domain (colored red and orange). The disulfide bond linking the two CTLA-4 domains is colored yellow. The CTLA4 domains are shown bound to CD86 (magenta) and CD80 (pink). The molecular surface of the CD86 binding site is colored white. (Courtesy of Dr. Stanley R. Krystek, Jr.) See articles by Vincenti et al on page 535 and Durrbach et al on page 547.
Cover design by Ken North of North Design Group.

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Volume 10 Issue 2 (February 2010)


Vol 10 Iss 2

In this issue, Guarrera et al report on a clinical trial of machine liver preservation. The system utilizes centrifugal flow via the portal vein and hepatic artery at 4–6°C. See article by Guarrera et al on page 372–381.
Cover design by Ken North of North Design Group.

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Volume 10 Supplement 2 (January 2010)


Vol 10 S2

Special Issue: AST Annual Scientific Exchange

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Volume 10 Supplement 1 (January 2010)


Vol 10 S1

Special Issue: ASTS 10th Annual State of the Art Winter Symposium

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Volume 10 Issue 1 (January 2010)


Vol 10 Iss 1

Recipients of MHC-mismatched cardiac allografts were treated with a single dose of 500 μg anti-TNFα mAb or rat IgG at the time of transplant. (A) The A/J allografts were retrieved from C57BL/6 recipients 9 and 12 hours posttransplant and prepared frozen sections were stained to detect graft infiltrating neutrophils. (B) Grafts were retrieved from groups of 4 recipients at the indicated times posttransplant and flow cytometry analyses of anti-CD45 and anti-Gr1 mAb stained cells from digested grafts were performed to determine numbers of neutrophils infiltrating the allografts. See article by Fairchild et al on page 59–68.
Cover design by Ken North of North Design Group.

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Volume 9 Supplement 4 (December 2009)


Vol 9 S4


Special Issue: AST Infectious Diseases Guidelines 2nd Edition

Top left: MRI of a brain in a patient with posttransplant lymphoproliferative disease. Provided by Dr. Marian Michaels, University of Pittsburgh.
Top right: Stain showing intracellular Legionella species bacteria. Provided by Dr. Sang-Oh Lee, University of Ulsan College of Medicine.
Bottom left: Absidia corymbifera gastro-intestinal tract infection in a heart–kidney transplant recipient. Provided by Dr. Philippe Hauser and Dr. Oriol Manuel, University Hospital of Lausanne.
Bottom right: Maculopapular rash in a lung transplant patient with disseminated human herpesvirus-6 infection.

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Volume 9 Issue 12 (December 2009)


Vol 9 Iss 12

In 297 kidney recipients with indication biopsies, focal C4d had similar impact on graft survival as diffuse pattern, and in patients biopsied in the first year, DSA was predictive of worse outcome regardless of C4d. Cover image shows graft survival estimates after biopsy by class I/II DSA status, overall and by time of DSA sampling. See Haririan et al, pages 2758–2767.

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Volume 9 Supplement 3 (November 2009)


Vol 9 S3

KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

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Volume 9 Issue 11 (November 2009)


Vol 9 Iss 11

See randomized clinical trial results by Servais, et al on page 2552.
Cover Design by Ken North of North Design Group.

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Volume 9 Issue 10 (October 2009)


Vol 9 Iss 10

See obituary by Terasaki on page 2441.
Photo Credit: Keystone/Stringer, Hulton Archive, Getty Images
Cover Design by Ken North of North Design Group.

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Volume 9 Issue 9 (September 2009)


Vol 9 Iss 9

Flow-cytometric analysis of peripheral blood mononuclear cells from healthy volunteers reveals that the CD4+ and CD8+ populations mount similar proliferative responses and contain comparable frequencies of alloreactive precursors. See article by Macedo et al, pages 2057–2066.

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Volume 9 Issue 8 (August 2009)


Vol 9 Iss 8

Rat lung tissue posttransplantation. See article by Shilling and Wilkes on page 1714.

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Volume 9 Issue 7 (July 2009)


Vol 9 Iss 7

This month's AJT looks at the Life Years from Transplant system of allocating kidneys. See Special Feature articles on pages 1500–1532.
Cover design by Ken North of the North Design Group.

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Volume 9 Issue 6 (June 2009)


Vol 9 Iss 6

Relationship between the total portal flow and graft regeneration. See article by Cheng et al on page 1382.
Cover design by Ken North of the North Design Group.

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Volume 9 Supplement 2 (May 2009)


Vol 9 S2


Special Issue: 2009 American Transplant Congress Abstracts

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Volume 9 Issue 5 (May 2009)


Vol 9 Iss 5

Migration patterns of B2 lymphocytes. B2 lymphocytes begin life in the bone marrow, then migrate to either the gut, lymph nodes or spleen where they remain quiescent until they encounter antigen in the presence of antigen-presenting cells and T-helper cells. Following a series of steps, B cells may become terminally differentiated PCs. Some PCs may migrate back to the bone marrow where they may persist for years in specialized antiapoptotic 'survival niches'. Please see minireview by Stegall et al on page 998.
Cover design by Ken North of the North Design Group.

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Volume 9 Supplement 1 (April 2009)


Vol 9 S1

The 2008 SRTR Report on the State of Transplantation

Mean five-year future lifetime by MELD. Average survival benefit from liver transplantation increases steadily as MELD increases. Benefit is defined as the difference between predicted years lived with a transplant versus without. See article by Schaubel et al on page 970.

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Volume 9 Issue 4 (April 2009)


Vol 9 Iss 4

Longitudinal analysis of EMT markers in bronchial brushing-derived epithelial cells. Epithelial cell expression of the EMT markers (α-sma and S100A4) and BAL cytokines (TGFβ1 and HGF) were measured in a highly sensitized (pretransplant panel reactive antibody 90%) 57-year-female recipient of a single lung transplant for usual interstitial pneumonia (UIP). The patient developed treatment refractory BOS following a late episode of acute rejection (A2B0) at 6-month posttransplant and an episode of CMV pneumonitis at 10-month posttransplant. Note increased expression of EMT markers, TGFβ1 and HGF concurrent with the diagnosis of BOS at 17 months after transplantation. No bronchial brushing samples were obtained at the last bronchoscopy at 20 months. αSMA = α-smooth muscle actin; S100A4; TGFβ1 = transforming growth factor β; HGF = hepatocyte growth factor; FEV1 = forced expiratory volume in 1 second; BAL = bronchoalveolar lavage; CMV = cytomegalovirus. Please see article by Hodge et al on pages 727–733.
Cover design by Ken North of the North Design Group.

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Volume 9 Issue 3 (March 2009)


Vol 9 Iss 3

Renal grafts function well and provide survival benefit in KAH and KAL recipients, but are limited in longevity by the general life expectancy of these recipients.
Top left: Renal graft survival in kidney after heart transplant recipients compared to matched controls.
Bottom left: Death-censored renal graft survival in kidney after heart transplant recipients compared to matched controls.
Top right: Renal graft survival in kidney after lung transplant recipients compared to matched controls.
Bottom right: Death-censored renal graft survival in kidney after lung transplant recipients compared to matched controls. See Lonze et al, pages 578–585.

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Volume 9 Issue 2 (February 2009)


Vol 9 Iss 2

Some potential regulatory and effector roles of NKG2D. Figure provided by Suárez-Álvarez et al (see article on pages 251–257) and designed by Ken North of North Design Group (Edmonton, Canada).

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Volume 9 Issue 1 (January 2009)


Vol 9 Iss 1

Figure provided by Djamali et al (see article on pages 74–82) and designed by Ken North of North Design Group (Edmonton, Canada).

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Volume 8 Issue 12 (December 2008)


Vol 8 Iss 12

Sarah, aged 1 year, died awaiting liver transplantation a few days after this photograph was taken by her mother. Her parents have since become vigorous activists for donation awareness in their community (reproduced with permission of K. Schonhoff). See special article by McDiarmid et al, pages 2491–2495.

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Volume 8 Issue 11 (November 2008)


Vol 8 Iss 11

Flow diagram of the process of UV-induced skin carcinoma, and the interference from the immunosuppressive drugs, azathioprine (Aza), cyclosporine (CS) and Rapamycin (Rapa). See minireview by Martinez and De Gruijl, pages 2205–2211, and special minireview series on 2185–2218.

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Volume 8 Issue 10 (October 2008)


Vol 8 Iss 10

Novel biologics and small molecules targeting cell surface receptors and intracellular pathways of the T cell. PKC = Protein Kinase C, CN = Calcineurin Inhibitor. See minireview by Vincenti and Kirk, pages 1972–1981.

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Volume 8 Issue 9 (September 2008)


Vol 8 Iss 9

Left figure: Shown is the cumulative survival of all heart transplant recipients at Stanford University over the 40-year period between 1968 and 2007, broken down into 5-year intervals. The cumulative survival continuously improved with every successive 5-year period. Sixty out of 479 patients transplanted before 1988 survived at least 20 years (grey box). The conditional half-life in this patient population was 28.1 years. See article by Deuse et al on pages 1769–1774.
Right figure: Cytochrome c immunostaining was performed after transplantation of wildtype (JNK2 +/+) and JNK2 deficient (JNK2 -/-) mouse livers after 30 h of cold storage. In JNK2 +/+ grafts, brown immunostaining for cytochrome c was diffuse, indicating cytochrome c release from mitochondria to the cytosol due to the mitochondrial permeability transition. In JNK2 -/- grafts, cytochrome c immunostaining was punctate, indicating mitochondrial retention of cytochrome c. Bar is 20 μm.
See article by Theruvath et al on pages 1819–1828.

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Volume 8 Issue 8 (August 2008)


Vol 8 Iss 8

Left Figure: Digital images from the electron microscopy of transplant glomerulopathy and peritubular capillary laminations.
A: Glomerular loop with new basement membrane (arrow), i.e., duplication, activated endothelium (arrow) and lumen with a red blood cell (RBC, arrow). Original magnification 7100x.
B: Glomerular loop with thickened basement membrane laminations (arrow), and activated endothelium (arrow). Podocytes for reference (arrow). Original magnification, 15000x.
C: Peritubular capillary with laminations (arrow) and activated endothelium (arrow). Peritubular capillary lumen for reference (PTC Lumen). Original magnification, 9100x. See article by Smith et al on pages 1662–1672.
Right Figure: ECD in Canada defined as donors ≥60 years of age. In the United States, expanded criteria donors (ECD) are donors age ≥60 years or donors aged 50–59 years with at least two of the following conditions: cerebrovascualar accident as cause of death, serum creatinine > 1.5 mg/dl or a history of hypertension. * 2007 Canadian data are preliminary and have not been verified. The number of SCD, ECD and DCD in the United States were obtained from reference 10 within the article by Gill et al on pages 1580–1587.

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Volume 8 Issue 7 (July 2008)


Vol 8 Iss 7

Figure 1. Immunohistochemistry for CCR1, CCR2 and CCR5 on lung allograft biopsy tissue with CMV disease, showing (A) type II pneumocytes (red arrows) and (B) alveolar macrophages (AM). Pulmonary CMVD biopsy specimen showing CCR1 expression predominantly by C) AM (green arrows), other mononuclear cells (blue arrows) and D) interstitial mast cells (orange arrows). Pulmonary CMVD biopsy specimen showing CCR5 localization to E) AM (green arrows), interstitial mast cells (orange arrows) and F) other mononuclear cells (blue arrows). All images were photographed at 400 x original magnication. See article by Weigt et al on pages 1512–1522.
Figure 2A. Acute rejection. Erythematous macules on the sentinel skin graft at day 20 post–partial face transplantation. Clinical involvement of >50% of the composite tissue graft.
Figure 2B. Regression of signs of skin rejection of the sentinel skin graft after increasing the immunossuppressive treatment.
Figure 2C. Banff 2007 Classification of Skin-Containing Composite Tissue Allograft Pathology Grade I rejection of the sentinel skin graft.
Figure 2D. Pathological appearance of the sentinel skin graft after increasing the immunosuppressive regimen.
See meeting report from Cendales et al on pages 1396–1400.

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Volume 8 Issue 6 (June 2008)


Vol 8 Iss 6

Figure 1. Acute T-cell mediated pancreas allograft rejection 5 years posttransplantation, triggered by decreased immunosuppression due to refractory viral infections. Two representative fields of the needle core biopsy demonstrate lymphocytic inflammatory infiltrates involving the glandular tissue, interstitium and vessels. CD8 stain highlights endothelial inflammation in an artery and a vein (center lower picture) and amidst the acinar cells (lower right). Asterisk in top left image marks active transplant arteriopathy (arterial intimal fibrosis with mononuclear inflammation), also indicative of ongoing T-cell mediated rejection. Please see article by Drachenberg et al on page 1237.
Figure 2. (A) Overall survival after primary liver transplantation (n=147) vs. liver resection in patients potentially eligible for LT (n=80); (B) Disease-free survival after primary LT (n=147) vs. LR in patients potentially eligible for LT (n=80). Please see article by Del Gaudio et al on page 1177.

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Volume 8 Issue 5 (May 2008)


Vol 8 Iss 5

Figure 1. Double-immunofluorescent immunohistochemistry of infiltrating CD3+ T-cells in CAV vessels. For a full description, see Figure 4 in the article by Hagemeijer et al, pages 1040–1050.
Figure 2. In this figure, Shimazono (2007) illustrates four modes of transplant tourism. Mode 1 entails a recipient traveling from Country B to Country A where the donor and transplant center are located; Mode 2 entails a donor from Country A traveling to Country B where the recipient and transplant center are located; Mode 3 entails a donor and recipient from Country A traveling to Country B where the transplant center is located; and Mode 4 entails a donor from Country A and a recipient from Country B traveling to Country C where the transplant center is located. Reproduced with permission from Yosuke Shimazono, University of Oxford Institute of Social and Cultural Anthropology. See Ethics Corner by Budiani-Saberi and Delmonico on pages 925–929.

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Volume 8 Supplement 2 (May 2008)


Vol 8 S2

Special Issue: 2008 American Transplant Congress Abstracts

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Volume 8 Issue 4 (April 2008)


Vol 8 Iss 4

The collage depicting the watchful eye symbolizes the vigilance that, on many different levels, monitors organ transplantation in the United States. See special feature by McDiarmid, Pruett and Graham on pages 739–744.
Cover Illustration by Andrew Swartz.

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Volume 8 Supplement 1 (April 2008)


Vol 8 S1

Special Issue: The 2007 SRTR Report on the State of Transplantation

These six graphs provide a quick view of transplant and waiting list activity in the United States over the past decade. (Multi-organ transplants are excluded.) Additional detail is given in the organ-specific articles of this report, as well as in the overview article by Port et al on pages 911–921.

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Volume 8 Issue 3 (March 2008)


Vol 8 Iss 3

Figure 1: Graft survival of MHC-mismatched A/J renal allografts in wild type C57BL/6 vs. B6.CCR5-/- recipients. Groups of wild type C57BL/6 (- -, n=8) and B6.CCR5-/- (-♦-, n=7) received renal allografts from A/J donors and graft survival was followed by daily examination of overall animal health and weekly serum creatinine checks. Allograft rejection was confirmed by histopathology. See article by Bickerstaff et al on pages 557–566.
Figure 2: Left: Characteristic glomerular features of TG, note extensive duplication of GBM (arrows); Right: TG is often a focal lesion affecting only some glomeruli (top but not the bottom glomerulus in this slide). By Banff criteria (17), the diagnosis of TG is based on the identification of duplicated GBM in more than 10% of glomerular capillary loops in the most affected non-sclerotic glomerulus. See minireview by Cosio et al on pages 492–496.

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Volume 8 Issue 2 (February 2008)


Vol 8 Iss 2

Top panel: Cumulative incidence of biopsy-proven acute rejection (BPAR) in patients randomized to steroid-free therapy, steroid withdrawal at Day 7, or standard steroids (Kaplan-Meier, ITT population). P=0.003 for the steroid-free group and p=0.03 for the steroid-withdrawal group, both versus the standard-steroids group (log rank test). See article by Vincenti et al on pages 307–316.
Bottom panel: A group of children who received heart transplants as infants at a picnic in June 2007 in Toronto, Ontario, Canada. Picture taken by Dr. Anne Dipchand and used with her permission and consent of the families involved. See article by Pollock-BarZiv et al on pages 412–418.

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Volume 8 Issue 1 (January 2008)


Vol 8 Iss 1

This figure illustrates the overall process from bone marrow aspiration to the performance of the allo-ASC functional assays. The pie chart demonstrates the percentages of each cell type in the CD 138* fraction of cells. Please see article by D.K. Perry et al in this issue on page 133. (The top panel of this figure was reproduced with permission from the Mayo Foundation for Medical Education and Research.)

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Volume 7 Issue 12 (December 2007)


Vol 7 Iss 12

Relationship between PBT scores, histopathologic lesions, histopathologic and clinical diagnosis, and classifier predictions. Biopsies for cause (n = 143) were sorted based on the CAT1 score (from lowest to highest). According to this order, scores for all PBTs (CAT1, CAT2, GRIT1, GRIT2, KT1, KT2) are illustrated for each individual biopsy for cause. The panel above the graph illustrates the relationship of the PBT scores to the presence of acute tubular necrosis (ATN), the degree of interstitial infiltrate (i score), tubulitis (t score), intimal arteritis (v score), histopathology diagnosis, retrospective clinical-pathologic diagnosis, and the probability of rejection (%), predicted from the classifiers. Please see article by Mueller et al on pages 2712–2722 of this issue.

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Volume 7 Issue 11 (November 2007)


Vol 7 Iss 11

Surface receptors, granules and the canalicular system of platelets. Different glycoprotein (GP) receptors that are expressed on the membrane of platelets can cause shape changes though connections to the cytoskeleton. GPIa and GPVI mediate direct binding to subendothelial collagen and GPIb mediates indirect binding to collagen via vWf. GPIIb/IIIa binds to fibrinogen, vWf, fibronectin and vitronectin. Cyclooxygenase (COX) is localized in the dense tubular system compartment where it converts arachidonic acid substrate into thromboxane. Each platelet contains about 40 storage granules. The most numerous are α-granules that contain adhesion molecules, chemokines, cytokines and growth factors, some of which are listed in Table 1. Dense granules contain serotonin and ATP/ADP. The contents of the granules are derived from the megakaryocyte when platelets are formed and also taken up from the plasma via the canalicular system. In addition to uptake of molecules from the plasma, the canalicular system facilitates the rapid exocytosis of granule contents. See article by Morrell et al on pages 2447–2454.

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Volume 7 Issue 10 (October 2007)


Vol 7 Iss 10

Left image: Time to (A) acute humoral and (B) cellular rejection in living donor renal transplant recipients, by DSA-status. See article by Patel et al on pages 2371–2377.
Right image: Incidence of de novo antibodies after islet transplantation. See article by Campbell et al on pages 2311–2317.

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Volume 7 Issue 9 (September 2007)


Vol 7 Iss 9

Left image: C4D staining of capillaries (top) and capillary endothelial swelling and leukocyte margination (bottom) in antibody-mediated heart transplant rejection. See article by Uber et al on pages 2064–2074.
Right image: Reduction in CMV viral load with time in patients treated with oral valganciclovir and intravenous valganciclovir. See article by Asberg et al on pages 2106–2113.

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Volume 7 Issue 8 (August 2007)


Vol 7 Iss 8

Left image: Dr. Olga Jonasson, the first woman transplant surgeon, 1934–2006. See special feature by Bartholomew et al on pages 1882–1883.
Right image: See article by Yamamoto et al on pages 1954–1960.

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Volume 7 Issue 7 (July 2007)


Vol 7 Iss 7

The first successful organ transplant. See special feature on pages 1683–1688.

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Volume 7 Issue 6 (June 2007)


Vol 7 Iss 6

Left panel: Organs procured and transplanted from deceased donors per million population in 2005 (Council of Europe data). See the editorial by Roels et al on page 1439 for more information.
Right panel: Age-specific donation rates for Spain and the United States in 2004. For more information, see Cuende et al on page 1526 of this issue.

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Volume 7 Issue 5 (May 2007)


Vol 7 Iss 5

Left image: New additions to the deceased donor renal transplant waiting list 2000–2005. See personal viewpoint by Freeman on pages 1043–1046.
Right image: Mouse cardiac allograft survival in wild-type and β3 integrin-deficient recipients. See article by Lacy-Hulbert et al on pages 1080–1090.

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Volume 7 Issue 4 (April 2007)


Vol 7 Iss 4

Left image: Schematic representation of tetracycline regulated systems. Conditional gene expression: a new tool for the transplantologist. See minireview by Maltzman and Turka, pages 733–740.
Right image: Estimated glomerular filtration rates underestimate graph functional loss in kidney transplants. See article by Gera et al on pages 880–887.

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Volume 7 Issue 3 (March 2007)


Vol 7 Iss 3

Left panel: This figure from the article by Ekberg et al on the results from the CAESAR Study on pages 560–570 shows first biopsy-proven acute rejection in renal transplant patients at 6 and 12 months as defined according to the Banff criteria.
Right panel: In this issue of AJT we highlight the Banff '05 meeting report on pages 518–526. This figure shows a 32-year-old man who had been originally diagnosed as membranoproliferative glomerulonephritis and received a kidney transplant. Nine years after transplantation, he developed severe tubular atrophy and interstitial fibrosis and graft failure with no evidence of any specific etiology (Masson trichrome, original magnification, x200).

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Volume 7 Issue 2 (February 2007)


Vol 7 Iss 2

Persistent inflammation in renal allografts detected by protocol biopsies. See article by Mengel et al on pages 356–365.

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Volume 7 Issue 1 (January 2007)


Vol 7 Iss 1

Left image: Paying tribute to Dr. Robert Zhong, 1946–2006. See tribute by Jevnikar and West on pages 12–13.
Right image: Loss in renal function after clinical islet transplantation. See article by Senior et al on pages 91–98.

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Volume 6 Issue 12 (December 2006)


Vol 6 Iss 12

Current issues in lung transplantation. See articles by Husain et al on pages 3000–3007 and 3008–3016.

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Volume 6 Issue 11 (November 2006)


Vol 6 Iss 11

Left image: Catheter subtraction angiography of a hepatocellular carcinoma.
Right image: Recurrent IgA nephropathy after renal transplant.

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Volume 6 Issue 10 (October 2006)


Vol 6 Iss 10

Emory algorithm for evaluating the sensitized patient. See article by Bray et al on pages 2307–2315.

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Volume 6 Issue 9 (September 2006)


Vol 6 Iss 9

Left image: BK virus DNA in several tubular epithelial cells. See article by Einecke et al on pages 2109–2120.
Right image: Decline in glomerular filtration rate after kidney transplant. See article by Canales et al on pages 2157–2163.

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Volume 6 Issue 8 (August 2006)


Vol 6 Iss 8

Emerging issues and insights in antibody-mediated rejection. See editorial by Sis et al on pages 1753–1754; articles by Colvin et al on pages 1790–1798, Haas et al on pages 1829–1840, Gloor et al on pages 1841–1847; and minireview by Soleimani et al on pages 1781–1785.

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Volume 6 Issue 7 (July 2006)


Vol 6 Iss 7

Pandemic influenza and its implications for transplantation. See minireview by Kumar and Humar on pages 1512–1517.

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Volume 6 Issue 6 (June 2006)


Vol 6 Iss 6

Cardiac allograft vasculopathy initiated and propagated by immunologic and nonimmunologic factors. See minireview by Mehra on pages 1248–1256.

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Volume 6 Issue 5 (May 2006)


Vol 6 Iss 5

The American Journal of Transplantation celebrates its fifth anniversary with minireviews, articles, and several brief communications.

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Volume 6 Issue 4 (April 2006)


Vol 6 Iss 4

Left image: Bilateral hand transplantation: five years later. See article by Schneeberger et al on pages 834–841.
Right image: Late kidney deterioration in two of ten patients with “operational tolerance." See article by Roussey-Kesler et al, pages 736–746.

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Volume 6 Issue 3 (March 2006)


Vol 6 Iss 3

Intravenous gammaglobulin (ivig) blocks cytotoxic anti-HLA antibodies in the panel reactive antibody system. See minireview by Jordan et al on pages 459–466.

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Volume 6 Issue 2 (February 2006)


Vol 6 Iss 2

Left Image: C4d staining of interacinar capillaries in a pancreas transplant with antibody-mediated rejection (top) versus control (bottom). See case report by Melcher et al, pages 423–428.
Right Image: Risk adjusted cumulative sum chart depicts renal transplant center with a cluster of graft failures.

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Volume 6 Issue 1 (January 2006)


Vol 6 Iss 1

Top image: Liver ischemia after intraportal islet transplantation: necrosis on liver surface (left) intraportal islet cluster with necrotic hepatic tissue (right). See minireview by Birchall et al on pages 20–26.
Bottom Image:
Laryngeal replantation technique in a human. See article on pages 60–68 by Yin et al.

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Volume 1 Issue 2 (July 2001)


Vol 1 Iss 2

Top image: Diagrammatic representation of the direct and indirect pathways of allorecognition. For more information, read Rogers and Lechler's minireview on pages 97–102.
Bottom left: Several methods exist to date for the detection of antigen-specific T cells. Read more in Volk and Kern's article on pages 109–114.
Bottom right: Trafficking of recipient dendritic cells throughout an allograft (and their role in mediating and maintaining indirect allorecognition). See Rogers and Lechler, pages 97–102.

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Volume 1 Issue 1 (May 2001)


Vol 1 Iss 1

In this seminal issue of the American Journal of Transplantation, read Editor-in-Chief Phil Halloran's welcome and explanation of why AJT came to be, and his expectations for the future. Read also an article about mechanisms of cardiac allograft rejection in mice by Szot et al on pages 38–46.

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